- Microsoft Word
- Crystal Reports
- Microsoft Office
The position supports the Executive Director, Directors, Assistant Directors, Managers and staff of the Department of Health Plan Strategy and Contracting in carrying out their responsibilities for contracting on behalf of UCSF Medical Group, Benioff Children’s Physicians (BCP), our Clinically Integrated Partners and UCSF Medical Center for services provided to members of health plans, government agencies, ACO Partners, other medical groups and third parties.
The position’s analytical skills play a key role in the Department and Medical Centers development, negotiation, projection and tracking of both physician (professional) reimbursement and hospital technical services reimbursement rates, as well as reporting financial results and communicating other significant developments to internal and external customers.
The position is principally engaged in data acquisition, contract term development and interpretation, financial modeling which includes creating, loading and debugging payment schedules, algorithms, underpayment identification reporting and general financial analysis, along with the maintenance of key shared information resources and systems. The individual in this position is able to communicate the complex medical group (physician) and medical center (hospital), billing, clinical coding and utilization data that is crucial for contracting with third parties.
Successful candidates in this position possess the background knowledge and skill that allow them to interpret analyze and synthesize a combination of clinical, technical (coding) and financial data, provide insights from their analyses and contribute information that will help improve the design and implementation of the payment structures and larger revenue strategies.
Three years related experience
In-depth knowledge of the workings of the Managed Care Contracting, Professional or Hospital Billing operations, Physician Fee Schedules and advanced analytics
Critical thinking and advanced problem-solving skills to manage highly-complex information, assess problems, and develop effective solutions
Excellent written and verbal communication skills with the ability to convey complex information in a clear, concise manner; ability to produce and deliver presentations to diverse audiences coupled with the patience and persistence to work with complex data and logical hierarchies
Demonstrated interpersonal skills for effective collaboration with managers, professional and technical staff
Excellent computer and analytical skills including problem identification/solving and an ability to prioritize and multi-task effectively to meet deadlines under pressure are required
Excellent interpersonal and telephone skills and an ability to effectively communicate in writing and orally with a variety of audiences are essential
Proficiency with Microsoft Office (Excel & Word) and MS Access
The flexibility to orient and work at all UCSF Medical Center locations
Knowledge of SQL, statistical or other business applications such as SAS, Quick Base, Cognos or Crystal Report Writer
Working knowledge of Epic
Experience in physician billing, claims and contract adjudication and follow-up or related analytical work - preferably in a hospital, medical insurance, group practice or managed care setting
Living Pride Standards
Demonstrates service excellence by following the Everyday PRIDE Guide with the UCSF Medical Center standards and expectations for communication and behavior. These standards and expectations convey specific behavior associated with the Medical Center’s values: Professionalism, Respect, Integrity, Diversity and Excellence, and provide guidance on how we communicate with patients, visitors, faculty, staff, and students, virtually everyone, every day and with every encounter. These standards include, but are not limited to: personal appearance, acknowledging and greeting all patients and families, introductions using AIDET, managing up, service recovery, managing delays and expectations, phone standards, electronic communication, team work, cultural sensitivity and competency.
Uses effective communication skills with patients and staff; demonstrates proper telephone techniques and etiquette; acts as an escort to any patient or family member needing directions; shows sensitivity to differences of culture; demonstrates a positive and supportive manner in which patients / families/ colleagues perceive interactions as positive and supportive. Exhibits team work skills to positively acknowledge and recognize other colleagues, and uses personal experiences to model and teach Living PRIDE standards.
Exhibits tact and professionalism in difficult situations according to PRIDE Values and Practices
Demonstrates an understanding of and adheres to privacy, confidentiality, and security policies and procedures related to Protected Health Information (PHI) or other sensitive and personal information.
Demonstrates an understanding of and adheres to safety and infection control policies and procedures.
Assumes accountability for improving quality metrics associated with department/unit and meeting organizational/departmental targets.
Keeps working areas neat, orderly and clutter-free, including the hallways. Adheres to cleaning processes and puts things back where they belong. Removes and reports broken equipment and furniture.
Picks up and disposes of any litter found throughout entire facility.
Posts flyers and posters in designated areas only; does not post on walls, doors or windows.
Knows where the Environment of Care Manual is kept in department; corrects or reports unsafe conditions to the appropriate departments.
Protects the physical environment and equipment from damage and theft.
The flexibility to orient and work at all UCSF Medical Center locations is required.
Equal Employment Opportunity
The University of California San Francisco is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Further information about the University of California, San Francisco, is available at diversity.ucsf.edu. UCSF seeks candidates whose skills, and personal and professional experience, have prepared them to contribute to our commitment to diversity and excellence, and the communities we serve.